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. 2020 Jun 2;1(6):182-189.
doi: 10.1302/2633-1462.16.BJO-2020-0043.R1. eCollection 2020 Jun.

Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority

Chloe E H Scott  1   2 , George Holland  1 , Matilda F R Powell-Bowns  1 , Caitlin M Brennan  1 , Matthew Gillespie  1 , Samuel P Mackenzie  1 , Nick D Clement  1 , Anish K Amin  1   2 , Tim O White  1   2 , Andrew D Duckworth  1   2
Affiliations

Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority

Chloe E H Scott et al. Bone Jt Open. .

Abstract

Aims: This study aims to define the epidemiology of trauma presenting to a single centre providing all orthopaedic trauma care for a population of ∼ 900,000 over the first 40 days of the COVID-19 pandemic compared to that presenting over the same period one year earlier. The secondary aim was to compare this with population mobility data obtained from Google.

Methods: A cross-sectional study of consecutive adult (> 13 years) patients with musculoskeletal trauma referred as either in-patients or out-patients over a 40-day period beginning on 5 March 2020, the date of the first reported UK COVID-19 death, was performed. This time period encompassed social distancing measures. This group was compared to a group of patients referred over the same calendar period in 2019 and to publicly available mobility data from Google.

Results: Orthopaedic trauma referrals reduced by 42% (1,056 compared to 1,820) during the study period, and by 58% (405 compared to 967) following national lockdown. Outpatient referrals reduced by 44%, and inpatient referrals by 36%, and the number of surgeries performed by 36%. The regional incidence of traumatic injury fell from 5.07 (95% confidence interval (CI) 4.79 to 5.35) to 2.94 (95% CI 2.52 to 3.32) per 100,000 population per day. Significant reductions were seen in injuries related to sports and alcohol consumption. No admissions occurred relating to major trauma (Injury Severity Score > 16) or violence against the person. Changes in population mobility and trauma volume from baseline correlated significantly (Pearson's correlation 0.749, 95% CI 0.58 to 0.85, p < 0.001). However, admissions related to fragility fractures remained unchanged compared to the 2019 baseline.

Conclusion: The profound changes in social behaviour and mobility during the early stages of the COVID-19 pandemic have directly correlated with a significant decrease in orthopaedic trauma referrals, but fragility fractures remained unaffected and provision for these patients should be maintained.Cite this article: Bone Joint Open 2020;1-6:182-189.

Keywords: Adult trauma; COVID-19; Social distancing.

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Conflict of interest statement

ICMJE COI statement: C. Scott reports editorial board membership of The Bone & Joint Journal and Bone & Joint Research, and consultancy and grants/grants pending from Stryker Orthopaedics, all of which are unrelated to this article. T. White reports consultancy from Acumed, and grants/grants pening from Acumed and Smith & Nephew, which are unrelated to this article. A. Duckworth reports grants from Scottish Government Quality Improvement Grant, Smith & Nephew, and Acumed, and book royalties from Elsevier and Taylor & Francis, all of which are unrelated to this article.

Figures

Fig. 1
Fig. 1
Distribution of inpatient and outpatient trauma volume for the 40-day period 5 March to 13 April 2020. The baseline trauma volume from 2019 is shown in red.
Fig. 2
Fig. 2
Cumulative number of patients with femoral fragility fractures for the 40-day period 5 March to 13 April for the years 2019 (baseline) and 2020 (COVID-19 pandemic).
Fig. 3
Fig. 3
Change from baseline in trauma volume and population mobility in the Edinburgh population for a) all trauma and b) patients admitted with fragility and non-fragility trauma.
See this image and copyright information in PMC

References

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